EGPAF is dedicated to advancing basic and operations research to improve the prevention, care, and treatment of HIV and AIDS, and to determine the most effective ways to administer these programs. Issues that have been or are being investigated by EGPAF research projects in Tanzania include:
- Identifying factors that hamper pediatric enrollment into care and treatment;
- Exploring the impact of PMTCT on improving RCH services;
- Integrating the Expanded Program on Immunization (EPI) with HIV care and treatment services; and,
- Exploring how HIV management training for RCH service providers impacts outcomes for HIV-positive mothers and HIV-exposed children.
EGPAF supports Tanzania’s Ministry of Health and Social Welfare (MOHSW) with technical support at national, regional and district levels. EGPAF works directly with individual districts and faith-based organizations to implement a broad range of HIV/AIDS services. EGPAF activities focus on:
- Expanding the provision of comprehensive PMTCT services;
- Improving access to HIV care and treatment;
- Reducing stigma and increasing awareness; and,
- Strengthening systems and building capacity.
EGPAF is a global advocate for the public policies benefitting women, children, and families living with and affected by HIV and AIDS worldwide. Working with key partners and the Government of Tanzania, EGPAF is striving to increase women’s access to high- quality PMTCT and care and treatment services by:
- Raising awareness of PMTCT with key opinion leaders and decision makers, including the first lady, members of Parliament and community leaders;
- Increasing male involvement in HIV testing and PMTCT service delivery;
- Collaborating with partners, such as the WAMA Foundation and Futures Group, journalists, and the community, to heighten awareness of pediatric AIDS issues;
- Strategically increasing visibility of HIV counseling and testing services at public events such as clinic openings, World AIDS Day events and the Tanzania international trade fair; and
- Providing community outreach on prevention and care and treatment of pediatric HIV/AIDS at all levels.
The LIFE Program
The overall vision of the LIFE Program (Linking Initiatives for the Elimination of Pediatric HIV) is the virtual elimination of pediatric HIV infection in the program's focus regions: Shinyanga, Mtwara, Tabora, Arusha, Kilimanjaro, Tabora, Mwanza, Coast (Pwani), and Zanzibar. The program's goal is to increase the quality, efficiency, and cost-effectiveness of comprehensive HIV and AIDS services, and to ensure a sustainable and locally-owned response. This goal will be achieved through three strategic objectives:
Implementation of Programs for the Prevention, Care, and Treatment of HIV/AIDS
- Increase access to integrated, quality, and comprehensive prevention of mother-to-child transmission, reproductive health, and community-based HIV and AIDS services
- Strengthen linkages and referral networks across service delivery points, and facility and community-based services to improve services and ensure a continuum of care
- Ensure sustainability through a strengthened health system and through the transfer of capacity, management, and oversight of activities to the local government and other local institutions
The goal of this project is to reduce the morbidity and mortality of adults and children living with HIV, and to improve the lives of children and their families affected by HIV. To do so, the project has the following strategic objectives:
- Increase access of HIV-infected individuals to a comprehensive package of community-based basic care and support services in focus regions
- Increase the number of HIV-infected or affected children receiving palliative care and basic supportive services in focus regions
- Expand access to HIV/AIDS care and treatment and quality laboratory services in Lindi and Shinyanga regions; and strengthen the quality and accessibility of pediatric HIV/AIDS care service
- Increase the capacity of districts and care and treatment clinics to utilize data for program management, quality assurance and improvement, strategic decision making, and dissemination of program performance to district leaders and policy makers in focus regions
- Strengthen the capacity of local organizations and district authorities in the provision and coordination of HIV care in focus regions
Helping Expand Antiretroviral Treatment for Families and Children (Project HEART)
Project HEART was launched in 2004 in Cote d’Ivoire, South Africa, Tanzania, and Zambia, and in 2006 in Mozambique. This eight-year project, funded through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the U.S. Centers for Disease Control and Prevention (CDC), saw dramatic results. In 2010, one out of every 10 PEPFAR-supported ART patients in sub-Saharan Africa received their treatment through Project HEART. By early 2012, more than one million men, women, and children received HIV care and support; more than 2.5 million pregnant women received HIV counseling and testing; more than 66,500 pediatric HIV infections were prevented; and more than half a million people started lifesaving antiretroviral therapy (ART). Working with a network of more than 215 international and local partners, Project HEART dramatically improved delivery of HIV/AIDS services and ultimately strengthened national health systems by:
- Supporting HIV prevention, care, and treatment services at more than 510 ART sites and 1,053 PMTCT sites throughout five countries
- Building the clinical, managerial, financial, and administrative capacity of local health providers and partners to more effectively provide HIV services
- Strengthening program and data quality
- Improving the technological and physical infrastructure of health facilities
- Providing sub-awards to local partners and the Ministries of Health (MOHs) at the district and provincial/regional levels, in coordination with capacity building
Project HEART’s innovative practices – most notably using a decentralized district approach, scaling up performance-based financing, and piloting new, easy-to-use technology – have served as best practices that have been authorized and disseminated by MOHs and other implementing partners.
In Tanzania, Project HEART established a close working relationship with the MOHSW by providing ongoing financial and technical support to build and strengthen the capacity of District Council Health Management Teams (CHMTs) and health service providers at all levels to plan, manage, and implement quality HIV/AIDS-related health care systems. EGPAF also supported the Child-Centered Family HIV Care Clinic at Kilimanjaro Christian Medical Center, which optimizes care for HIV-infected children and their families. EGPAF’s additional initiatives targeting children included the early infant diagnosis (EID) program, which operated in 90 sites and enrolled over 1,500 HIV-exposed infants into follow-up care and treatment, and the provider-initiated testing and counseling program, which was implemented in entry points of all 165 EGPAF-supported care and treatment sites.
Enhancing Family Planning Counseling and Provision of Services through Integration into HIV Care and Treatment Services in the Shinyanga Region of Tanzania
The United Nations Population Fund is supporting the Elizabeth Glaser Pediatric AIDS Foundation to implement and evaluate a family planning (FP)/HIV integration model in Shinyanga Region in Tanzania. The FP/HIV integration model is defined as the co-location of FP and HIV care and treatment services at care and treatment centers (CTCs). This model involves the provision of family planning screening, counseling, and commodities to CTC clients. Strategies to support this integration include healthcare provider training on counseling, provision, and documentation of FP services to CTC clients; support to district leadership to ensure overall coordination of implementation, including site supervision and supply management and distribution; and orientation of community-level workers on availability of FP at CTC. The overall study aim is to assess changes resulting from the integration of FP services into HIV services and to assess the acceptability of the integrated model among district health managers, healthcare providers, and clients.
Prior to implementation of the integration model, a baseline assessment evaluated FP needs and services provided to HIV-positive adult CTC clients. The results of the baseline assessment indicated that a majority of respondents wanted to delay or prevent pregnancy and may benefit from availability of FP counseling and commodities in CTCs. Follow-up surveys will be administered nearly one year following the implementation of the model to assess changes in family planning practices.
This research builds on national-level momentum, and is aligned with national policy changes in Tanzania to integration FP and HIV services. Current evidence is limited on the FP/HIV integration model’s acceptability and impact on uptake of family planning services. The results from this study will provide valuable feedback to the Ministry of Health & Social Welfare, implementing partners, and other stakeholders and guide implementation and scale-up of this intervention throughout the country.
Providing Technical Assistance for Prevention of Mother-to-Child Transmission of HIV Services in the Republic of Tanzania
The objective of the bilateral agreement with USAID/Tanzania was to expand access to PMTCT services and strengthen linkages for pregnant women and their HIV-exposed infants to care and treatment within the public setting. EGPAF focused on integrating PMTCT services into routine maternal-child health services. Since the start of its PMTCT program in 2003, EGPAF has significantly contributed to the goal of the Tanzanian Ministry of Health and Social Welfare (MOHSW) and the United States Government to expand and improve PMTCT services in Tanzania. This program sought to:
- Increase access to quality PMTCT services, including linkages to care and treatment for women, children, and their families in Tanzania
- Support the MOHSW in rolling out the national PMTCT program using national guidelines and training curricula
- Increase the number of women and families enrolled in care and treatment programs by strengthening linkages between PMTCT and care and treatment
- Increase uptake of ARV prophylaxis in HIV-positive pregnant women and HIV-exposed infants
- Scale up the use of combination regimens in PMTCTStrengthen the integration of PMTCT and maternal and neonatal health services to contribute to the improvement of maternal and neonatal health
By the end of the project, EGPAF’s program contributed to approximately 27% of the national PMTCT coverage of pregnant women tested, and supported 25% of health facilities nationwide (1,065) providing PMTCT. EGPAF supported services in the regions of Arusha, Kilimanjaro, Mtwara, Shinyanga, and Tabora through 37 sub-grants, primarily with district councils. In these five regions, the geographic coverage of PMTCT services was greater than 80%, and the program tested more than 1,556,260 pregnant women since project inception.
Call to Action
Through funding from the United States Agency for International Development (USAID) and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), EGPAF implemented the eight‐year global Call to Action (CTA) project in 12 countries, including Tanzania (from 2002 through 2007). This project sought to improve access and expand care and support for quality prevention of mother-to-child transmission of HIV (PMTCT) services, while enhancing technical leadership and documenting successful program models. By project end, EGPAF had provided nearly four million women with access to PMTCT and antenatal care services. In Tanzania, EGPAF supported 428 health facilities and provided counseling and testing services to nearly 450,000 women.
Between 2003 and 2007, the CTA project, with the Tanzania Ministry of Health & Social Welfare (MOHSW), used a district approach to support the rapid scale-up of PMTCT services in five regions of the country to address the need for increased access to PMTCT in Tanzania. This district approach was consistent with the government’s national decentralization policy to enhance the speed and quality of the scale-up process, as well as to promote the long-term sustainability of services through the integration of PMTCT activities into existing structures and systems. With this approach, the government was able to dramatically scale up both the number of sites offering PMTCT services and the number of pregnant women being served. Key elements of this approach included building technical capacity to ensure rapid service expansion and continuity at the district level; ensuring financial sustainability of program activities; and creating mechanisms for ongoing supportive supervision and monitoring. The district approach was documented in a publication that was widely shared across EGPAF country programs.
Reaching More in Need: PMTCT Enhancement through Expanded Implementation and Operations Research
(The Bill and Melinda Gates Foundation: 2006–2011)
The Bill and Melinda Gates Foundation funded this project, which was designed to expand access to prevention of mother-to-child transmission of HIV (PMTCT) services in 10 countries including Tanzania, which allowed EGPAF to fill critical gaps, ensure continued service delivery in resource-limited countries, and leverage other donor resources to increase access to PMTCT services. Through this project, EGPAF:
Engaging People Living with HIV as Lay Counselors in HIV Care and Treatment Services
(Abbott Fund: 2007–2009)
- Provided support and technical assistance to host country governments to strengthen commitment to scale up PMTCT services
- Trained thousands of government personnel at the site, district, and provincial levels to build health care worker capacity to provide HIV services
- Strengthened integration with other essential services
- Improved linkages to care and treatment
This two-year pilot project was designed to evaluate the effectiveness of training people living with HIV to work as lay counselors at health facilities in their communities in the Moshi and Rombo districts of Tanzania. The 68 lay counselors trained over the two-year period increased the accessibility and acceptability of HIV services and improved the quality of HIV/AIDS care. Their contributions were met with widespread acceptance and enthusiasm not just by beneficiaries, but by health workers as well. Lay counselors have been shown to be capable of linking the community to the care and treatment centers, and to provider-initiative testing and counseling in particular. They also have been effective in helping to trace and follow up with HIV-exposed and HIV-infected children, and are thus instrumental in overcoming hurdles in the provision of a comprehensive continuum of care for HIV-positive women, their children, and their families. Moreover, the lay counselors were empowered by this program in terms of their own HIV awareness, personal development, and economic stability.
Pediatric Palliative Care Training
(Diana Princess of Wales Memorial Fund: 2012)
The goal of this project was to provide comprehensive care to children, including the relief of suffering, to improve the quality of life of children with chronic conditions including HIV. The project sought to:
- Prepare health facility staff to provide pediatric palliative care
- Capacitate families and communities in identifying and managing conditions that need palliative care for children
The DPWMF-funded training successfully motivated participants to improve the care provided to children in their current work environments. Participants acquired knowledge and skills in pediatric palliative care, including pain relief management and how to care for a child with life-threatening conditions.